prior authorization

Prior authorization is a process used by insurance companies to decide if a specific medical service, medication, or procedure will be covered. Before a healthcare provider can proceed, they submit a request to the insurer, explaining why the treatment is needed. The insurance reviews this request to ensure it’s medically appropriate and cost-effective. If approved, the patient can proceed with the treatment with coverage; if denied, they may need to explore alternative options. This process helps manage healthcare costs and ensures treatments meet certain standards.